Abstract
BackgroundStressful situations during intraoperative emergencies have negative impact on human cognitive functions. Consequently, task performance may decrease and patient safety may be compromised. Cognitive aids can counteract these effects and support anesthesiologists in their crisis management. The Professional Association of German Anesthesiologists set up a project to develop a comprehensive set of digital cognitive aids for intraoperative emergencies. A parallel development for several software platforms and stationary and mobile devices will accommodate the inhomogeneity of the information technology infrastructure within German anesthesia departments.ObjectiveThis paper aimed to provide a detailed overview of how the task of developing a digital cognitive aid for intraoperative crisis management in anesthesia was addressed that meets user requirements and is highly user-friendly.MethodsA user-centered design (UCD) process was conducted to identify, specify, and supplement the requirements for a digital cognitive aid. The study covered 4 aspects: analysis of the context of use, specification of user requirements, development of design solutions, and evaluation of design solutions. Three prototypes were developed and evaluated by end users of the application. Following each evaluation, the new requirements were prioritized and used for redesign. For the first and third prototype, the System Usability Scale (SUS) score was determined. The second prototype was evaluated with an extensive Web-based questionnaire. The evaluation of the third prototype included a think-aloud protocol.ResultsThe chosen methods enabled a comprehensive collection of requirements and helped to improve the design of the application. The first prototype achieved an average SUS score of 74 (SD 12), indicating good usability. The second prototype included the following main revisions: 2-column layout, initial selection of patient type (infant, adult, or parturient), 4 offered search options, and the option to check off completed action steps. Its evaluation identified the following major revision points: add quick selection for resuscitation checklists, design the top bar and tabs slightly larger, and add more pictograms to the text. The third prototype achieved an average SUS score of 77 (SD 15). The evaluation of the think-aloud protocol revealed a good intuitiveness of the application and identified a missing home button as the main issue.ConclusionsAnesthesiology—as an acute medical field—is particularly characterized by its high demands on decision making and action in dynamic, or time-critical situations. The integration of usability aspects is essential for everyday and emergency suitability. The UCD process allowed us to develop a prototypical digital cognitive aid, exhibiting high usability and user satisfaction in the demanding environment of anesthesiological emergencies. Both aspects are essential to increase the acceptance of the application in later stages. The study approach, combining different methods for determining user requirements, may be useful for other implementation projects in a highly demanding environment.
Highlights
BackgroundIntraoperative emergencies require rapid, coordinated management in time-critical and stressful settings
The development of this cognitive aid is based on the user-centered design (UCD) process of the International Organization for Standardization (ISO) norm 9241-210 [7], which has recently been performed for the development of other applications in the medical context [8,9,10]
Anesthesiologists in the inpatient and outpatient area were identified as the primary target group for the digital cognitive aid
Summary
BackgroundIntraoperative emergencies require rapid, coordinated management in time-critical and stressful settings. Cognitive aids can remind clinicians of important diagnostic causes, guide them on the basis of current evidence-based practices through a sequence of complex steps, and prevent them from omitting key actions [5]. These aids should anticipate common pitfalls of the particular emergency, provide prioritized and explicit instructions to prevent them, and contain important local information (eg, phone numbers, depositories of critical drugs, and precalculated drug dosages) that may help increase the speed and fluidity of performance. Stressful situations during intraoperative emergencies have negative impact on human cognitive functions. A parallel development for several software platforms and stationary and mobile devices will accommodate the inhomogeneity of the information technology infrastructure within German anesthesia departments
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